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Evaluation of Patients' Posture and Gait Profile After Lumbar Fusion Surgery by Video Rasterstereography and Treadmill Gait Analysis
Published on: March 23, 2019
Cervical Sagittal Alignment and Patient-Reported Outcomes in Posterior Cervical Fusion: A Longitudinal Comparative
Daniel W Griepp1, Michael H Lawless2, Ascher B Kaufmann3
1Division of Neurosurgery, Henry Ford Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA.
Background:
The impact of cervical sagittal parameters on patient-reported outcomes (PRO) after posterior cervical fusion (PCF) remains inconclusive. We sought to evaluate whether normative sagittal cervical alignment was independently associated with improved PRO.
Methods:
Retrospective review of consecutive patients who underwent PCF for degenerative conditions from January 2016 to December 2020 at a single institution with multiple surgeons. Cervical sagittal vertical axis (cSVA), McGregor's slope (McGS), and T1 slope minus C2-7 lordosis (T1S-CL) were measured using standing neutral lateral radiographs at preoperative and 1 year postoperatively. Normative parameters were defined as cSVA ≤4 cm, -5° ≤ McGS ≤ 15°, and T1S-CL < 20°. The primary outcome was the minimum clinically important difference (MCID) among validated PRO (12-item Short Form Mental and Physical Component Summaries, Neck Disability Index, neck and arm numeric rating scale, and modified Japanese Orthopaedic Association scale) collected prospectively preoperatively, 6 months, and 1 year postoperatively. Univariate analysis was used to compare demographics, operative characteristics, and proportions achieving MCID between parameter groups. Multiple logistic regression models were used to adjust for confounders. Radiographic parameters were included as the predictor. P < 0.05 was considered significant.
Results:
One hundred and four patients (54 men and 50 women with a mean age of 61.8 ± 10.6 years), were included. Operative levels ranged from C2 to T3, with 4 to 8 operative levels. Normative cSVA patients were younger (59.4 vs 67.5 years, P < 0.001) and had more prior anterior surgery (63% vs 38.7%, P = 0.019). All PRO showed significant improvement at 1-year follow-up, with proportions achieving MCID ranging from 51.9% (visual analog scale neck) to 31.7% (modified Japanese Orthopaedic Association). There was no significant PRO difference between normative and non-normative groups. Change of McGS, cSVA, or T1S-CL from non-normative to normative parameter was not independently associated with increased odds of achieving MCID for PRO.
Conclusion:
In this retrospective cohort study of patients undergoing multi-level PCF, achievement of MCID in PRO was comparable between patients with normative and non-normative postoperative cervical sagittal alignment.
Clinical Relevance:
Normative cervical cSVA, McGS, or T1S-CL following PCF surgery is not independently associated with improvement in PRO.
